Provider Demographics
NPI:1558031559
Name:GAINESVILLE STAR DIALYSIS
Entity Type:Organization
Organization Name:GAINESVILLE STAR DIALYSIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ASGAONKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-437-5789
Mailing Address - Street 1:3400 CORINTH PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76208-1313
Mailing Address - Country:US
Mailing Address - Phone:940-226-0206
Mailing Address - Fax:
Practice Address - Street 1:834 W HIGHWAY 82 STE 105
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-2524
Practice Address - Country:US
Practice Address - Phone:512-826-3696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110658OtherESRD LICENSE